Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version

DESCRIPTION

This guideline covers injuries to the fingers or toes. Usually the impact simply causes a bruise or swelling of the soft tissues and underlying bone. However, if the end of a straightened finger or thumb receives the blow (usually from a ball), the energy is absorbed by the joint surfaces and the injury occurs there (a jammed finger). If a finger is jammed, always check carefully that the end of the finger can be fully straightened.

In crush injuries (as from slammed car doors), usually the end of the finger or toe receives a few cuts. Occasionally the fingernail is damaged and the nailbed requires stitches. Rarely is there any fracture of the small underlying bone.

HOME CARE

1. Bruised finger or toe

   Soak it in cold water for 20 minutes. Give your child acetaminophen or ibuprofen as necessary for the pain. Call your child's physician if the pain is not improving by 3 days.

2. Jammed finger

   Soak the hand in cold water for 20 minutes. Give acetaminophen or ibuprofen as necessary for the pain. (Avoid aspirin because it may prolong the bleeding.) It's going to be sensitive for the next week, so protect it by "buddy-taping" it to the next finger. A splint could be used but often makes it more prone to getting bumped. Call your child's physician if the pain is not improving within 3 days.

3. Smashed or crushed fingertip

   Before taking care of this yourself, check the guidelines on when to call your child's physician.

   Soak the hand in cold water for 20 minutes. Give your child acetaminophen or ibuprofen as necessary for the pain. (Avoid aspirin because it may prolong the bleeding.) Call your child's physician if any signs of infection develop or the pain hasn't improved in 3 days.

4. Torn nail

   These recommendations apply to a nail that has been torn by catching on something. If the nail was torn by a crush injury, your child needs to see a physician. If the nail is cracked but there are no rough edges, leave it alone.

   If the nail is almost torn through or there is a large flap of nail, use sterile scissors or nail clippers to cut along the line of the tear. Pieces of nail taped in place will catch on objects. Soak the finger for 20 minutes in cold water. Apply an antibiotic ointment (such as bacitracin or Betadine) and cover it with a Band-Aid. Each day, remove the dressing and soak the finger in a warm salt solution (1/2 teaspoon of salt to a pint of water).

   By the seventh day, the nailbed should be covered with new skin, and both the soaking and the bandaging can be stopped. A new nail will grow in over the next 1 to 2 months. Call your child's physician if you see any signs of infection.

5. Superficial cuts

   Wash the wound vigorously with soap and water for 5 minutes. Then apply pressure for 10 minutes with a sterile gauze to stop bleeding. Leave the area exposed to the air.

6. Skinned knuckles

   These wounds are deep scrapes of the upper surfaces of fingers or toes. Wash the wound vigorously for 5 minutes with water and liquid soap. Scrubbing with a sterile gauze may be necessary to get all the dirt out. Flaps of skin (especially if they are dirty) should be cut off with sterile scissors. When the wound is clean, apply pressure for 10 minutes with a sterile gauze to stop any bleeding. Apply an antibiotic ointment and cover with a Band-Aid. Remove the dressing and clean the wound each day. Call your child's physician if you see any signs of infection.

7. Ring caught on swollen finger

   In most cases, the ring can be saved rather than cut off. The key to removing the ring is reducing the swelling of the finger. This approach requires patience. At 5-minute intervals, alternate soaking the hand in cold water and holding it (with all the fingers straightened) high in the air. At 30 minutes (after the hand has been elevated for the third time), put mineral oil or cooking oil on the finger. While the hand remains elevated, push the ring with steady upward pressure until it slides off. If it won't slide off, call your child's physician immediately before the swelling becomes worse.

8. Puncture wound

See Puncture Wounds.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

• The skin is split open and may need stitches.
• Blood collects under a nail AND becomes very painful.
• There is any dirt or grime in the wound you can't get out.
• A crush injury has damaged the skin or fingernail.
• A finger can't be opened (straightened) and closed (bent) completely.

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:

• The injury looks infected.
• Your child is not using the finger or toe normally after 1 week.
• You have other questions or concerns.